From the Guidelines
Post-viral cough typically resolves within 3 to 8 weeks without treatment, though it can occasionally persist for up to 3 months. For symptom relief, over-the-counter options include dextromethorphan (15-30 mg every 6-8 hours) for cough suppression, guaifenesin (200-400 mg every 4 hours) to thin mucus, and honey (1-2 teaspoons as needed) for throat irritation. Staying hydrated, using a humidifier, and avoiding irritants like smoke can help manage symptoms.
Key Considerations
- The timeline for resolution of post-viral cough can vary, but most cases resolve within 3 to 8 weeks 1.
- For persistent coughs, prescription options may include inhaled corticosteroids like budesonide (180-360 mcg twice daily for 2-4 weeks), short courses of oral steroids like prednisone (40-60 mg daily for 5-7 days with tapering), or ipratropium bromide nasal spray (2 sprays per nostril 2-3 times daily) for postnasal drip 1.
- Antibiotics are not effective since the cause is viral, not bacterial 1.
Management Strategies
- Identify and address underlying causes of cough, such as postnasal drip or gastroesophageal reflux disease 1.
- Consider a trial of inhaled ipratropium to attenuate the cough 1.
- In patients with postinfectious cough, when the cough adversely affects the patient’s quality of life and when cough persists despite use of inhaled ipratropium, consider the use of inhaled corticosteroids 1.
- For severe paroxysms of postinfectious cough, consider prescribing 30 to 40 mg of prednisone per day for a short, finite period of time when other common causes of cough have been ruled out 1.
Warning Signs
- If a cough persists beyond 8 weeks or is accompanied by warning signs like fever, chest pain, or shortness of breath, medical evaluation is recommended to rule out complications or alternative diagnoses 1.
From the FDA Drug Label
If pregnant or breast-feeding, ask a health professional before use. Stop use and ask a doctor if • cough lasts more than 7 days, • cough comes back, • or occurs with fever, rash or headache that lasts. These could be signs of a serious condition.
The timeline for resolution of post-viral cough is not explicitly stated, but it is recommended to stop use and ask a doctor if the cough lasts more than 7 days. Recommended treatments are not directly stated in the label, but it advises to ask a doctor if the cough lasts more than 7 days, comes back, or occurs with fever, rash, or headache that lasts 2.
From the Research
Timeline for Resolution of Post-Viral Cough
- The duration of post-viral cough can vary, but it is generally defined as lasting 3 to 8 weeks after an upper respiratory tract infection 3.
- Some studies suggest that post-COVID-19 chronic cough can last more than 8 weeks, with most patients exhibiting improvement at 60 days after the first visit 4.
- The exact timeline for resolution of post-viral cough can depend on various factors, including the severity of the initial infection and the presence of underlying respiratory conditions.
Recommended Treatments for Post-Viral Cough
- Inhaled corticosteroids may be effective in suppressing airway inflammation and improving lung function in patients with post-viral cough, particularly those with post-COVID-19 chronic cough 5, 4.
- Non-pharmacological remedies, such as honey, glycerol, and herbal agents, may also be effective in relieving post-viral acute cough, although further studies are needed to confirm their efficacy and safety 6.
- Symptomatic treatment options, such as cough relievers and saline solutions, may also be used to manage post-viral cough, although their effectiveness is poorly understood and lacking a robust evidence base 7.
- Oral corticosteroids are being investigated as a potential treatment for post-infectious cough, with a randomized controlled trial currently underway to evaluate their effectiveness and safety 3.